In a September 2014 Discussion Note, the Willamette Partnership looked at trends in hospital expenditures on charity care in states between the first quarter of 2014 and the first quarter of 2013. For the 6 states in the study that expanded Medicaid in January 2014, the Partnership found, on average, a 30% decrease in charity care and a 28% decrease in bad debt expenditures between the two quarters. This drop is largely caused by significant growth in Medicaid enrollments in these states.

In dollar terms, the $737 million less hospitals are spending on charity care in CA, CO, MD, NV, OR, and WA does not necessarily translate into available funds for community health projects. Medicaid underpayments (the difference between what hospitals charge and what is paid by Medicaid), could grow in some states as Medicaid rolls increase.

The Partnership begins to make the case that as hospitals think about how they provide their community benefits, they should consider nature and access to nature as an important aspect of community health. Hospitals and public health departments around the country are exploring how nature plays a role in improving health, and the Partnership would like to see much more of that happen. Doctors are writing prescriptions to visit parks in Washington, DC, hospitals in Oregon are building gardens and are seeing faster recovery times, and public health departments are helping fund trails and greenways in Alabama.

This study provide a quick snapshot into a trend where hospitals are likely to play a growing role in community health programs in the near future, and how nature and access to nature should be part of that conversation.